Inpatient Facility Coding & Compliance Alert

Question: Our provider treated a 4-year-old girl for nursemaid’s elbow after she fell on the ground last week. Which procedure code and ICD-9 code should I report on this claim?

Alabama Subscriber

Answer : Report the procedure with 24640 (Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation). Remember to link 832.2 (Nursemaid’s elbow) to 24640 to represent the patient’s condition on the claim,

You should typically be able to report a separate evaluation and management code along with 24640, assuming that the provider has documented an appropriate history, examination of the patient, and medical decision-making that he performed evaluating the trauma before treating the injury.

If the procedural notes justify a separate E/M along with 24640, remember to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code. Optimal documentation should  provide separate evaluation/management and procedure notes. Distinct diagnoses linked to each CPT® code, although not absolutely necessary, would be best.